Poppers

Poppers are recreational drugs belonging to the alkyl nitrite family of chemical compounds. When fumes from these substances are inhaled, they act as potent vasodilators, producing mild euphoria, warmth, and dizziness. Most effects have a rapid onset and are short-acting. Their recreational use is believed to be potentially dangerous for people with heart problems, anaemia, or glaucoma. Reported adverse effects include fainting, retinal toxicity, and vision loss. As poppers include a broad range of chemical types, their legality differs across different jurisdictions. They are often packaged under the guise of room deodorizer, leather polish, nail polish remover, or videotape head cleaner to evade anti-drug laws. The term poppers comes from the popping sound made when glass vials of the substance were crushed to release the vapors for inhalation. Amyl nitrite was originally prescribed in the late 1800s for the medical management of angina. Many analogues exist, such as isoamyl nitrite, isopentyl nitrite, isopropyl nitrite, and isobutyl nitrite. These substances are subject to different regulations; for example, isobutyl nitrite is banned in the European Union. Poppers act as muscle relaxants, causing the relaxation of involuntary smooth muscles such as the throat and anus. Such physiological effects, along with others (such as mild euphoria), have resulted in poppers being used as recreational drugs, sometimes during sexual intercourse, as the effects can heighten arousal and help facilitate acts such as anal intercourse. Poppers were a part of the club culture which began during the mid-1970s disco scene, and surged in popularity during the rave scene of the 1980s and 1990s.

Administration and effects

Administration Poppers come in liquid form, but this liquid is not directly consumed. When the bottle is opened, the vapors are inhaled, rather than the liquid. This is typically done through the nasal cavities, typically directly from the bottle, without touching the bottle to the skin, or with the help of small inhalers.

Effects

Physiological effects Inhaling nitrites produces a fast-acting, short-lived and non-specific relaxation of smooth muscles (along with the sphincter muscles of the anus and the vagina). Blood vessels are surrounded by smooth musculature, which directly influences blood pressure by increasing or decreasing its inward pressure on the blood vessels. With relaxation of the smooth muscles, the 'inward' pressure on the blood vessels decreases and they dilate, resulting in a drop in blood pressure and an immediate (compensatory) increase in heart rate (reflex tachycardia). Vasodilation may cause giddiness, dizziness, headache, nausea, vomiting and flushing, and may produce a sensation of heat and excitement. Maximum vasodilatory effect is usually reached within 30 seconds, with (secondary) physiological effects lasting for 5 to 10 minutes.

Psychological effects Inhaling nitrites produces several psychological effects such as euphoria, increased sensual awareness, lowered inhibitions or increased confidence, and potential for impaired judgement and disorientation.

Interactions

Vasodilators

Alkyl nitrites interact with other vasodilators, such as sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis), to cause a serious decrease in blood pressure, which can cause strokes, and low blood pressure leading to people fainting. Side effects of popper abuse include tachycardia, headaches, migraines, dizziness and fainting.

Toxicity The Merck Manual of Diagnosis and Therapy reports insignificant hazard associated with inhalation of alkyl nitrites, and British governmental guidance on the relative harmfulness of alkyl nitrites places them among the less harmful of recreational drugs. If in contact with the skin, butyl nitrite poppers can cause chemical burns and contact dermatitis of the skin around the mouth and nose. Swallowing poppers (rather than inhaling the vapour) may cause cyanosis, methemoglobinemia, unconsciousness, coma and complications leading to death. Accidental aspiration of amyl or butyl nitrites may cause lipoid pneumonia. Health officials are reporting an increase in deaths and hospitalizations associated with the intentional consumption or inhalation of nitrite products for recreational purposes, including to enhance sexual performance.

Isopropyl nitrite Isopropyl nitrite poppers may be a cause of maculopathy (eye damage), as reported in France and the United Kingdom. Some studies have concluded that there may be increased risk for at least temporary retinal damage with habitual poppers use in certain users; in a letter to the New England Journal of Medicine, an ophthalmologist described four cases in which recreational users of isopropyl nitrite poppers suffered temporary changes in vision. In November 2014, it was observed that maculopathy is a rare complication of isopropyl nitrite abuse. A full recovery of visual acuity in longterm abuse could be demonstrated after drug abstinence. Studies have shown that poppers users who have HIV and/or use Sildenafil in combination with poppers are at an increased risk of developing poppers‐associated maculopathy. Foveal (center-of-gaze) damage has also been described, in six habitual users of isopropyl nitrite poppers. Furthermore, in June 2014, optometrists and ophthalmologists reported having noticed an increase in vision loss in chronic poppers users in the United Kingdom associated with isopropyl nitrite (substitute for isobutyl nitrite which was banned in 2007).

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